Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

Abstract

Objective: To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation.

Design: Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems (TBIMS).

Setting: Inpatient rehabilitation hospitals participating in the TBIMS program.

Participants: Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]).

Interventions: Not applicable.

Main outcome measures: FIM items.

Results: For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years.

Conclusions: Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.

Keywords: Cognition; Consciousness disorders; DOC; DRS; Disability Rating Scale; GCS; GOS; Glasgow Coma Score; Glasgow Outcome Scale; MCS; Minimally conscious state; PTA; Prognosis; Rehabilitation; Rehabilitation outcome; TBI; TBIMS; Traumatic Brain Injury Model Systems; Traumatic brain injuries; VS; Vegetative state; disorders of consciousness; minimally conscious state; posttraumatic amnesia; traumatic brain injury; vegetative state.